Heart Disease in Women Often Hides Behind Subtle Symptoms, Cardiologists Warn

“Many women don’t experience the ‘classic’ crushing chest pain. Their body signals trouble in quieter ways that are too often overlooked.”

Heart disease in women frequently presents with symptoms that differ from the widely recognised signs seen in men, making early diagnosis more challenging, according to cardiologists. While chest pain or pressure can occur, many women experience less obvious symptoms that may be mistaken for digestive issues, anxiety or fatigue.

Doctors say symptoms such as nausea, vomiting, fainting, shortness of breath, indigestion and extreme tiredness should not be ignored, particularly if they appear suddenly or worsen without explanation.

Medical experts also advise considering factors unique to women’s health, including high blood pressure during pregnancy, menopause, hormone replacement therapy and the use of hormonal birth control, when assessing cardiovascular risk.

Specialists stress that the list of warning signs is not exhaustive. Some symptoms originate outside the chest because the heart and stomach share nerve pathways, meaning heart disease can sometimes resemble gastrointestinal illness.

Dr Sirisha Vadali, a cardiologist at HonorHealth in Scottsdale, Arizona, who specialises in women’s heart disease, said many women are unaware that indigestion, nausea and gastrointestinal distress can signal an underlying heart problem.

“Lesser-known external factors are vital to getting an accurate diagnosis,” Vadali said.

She also encouraged women to pay attention to subtle physical changes, even when they do not appear directly related to the heart. Reflecting on patients whose symptoms were initially difficult to recognise, Vadali said many women instinctively sense something is wrong despite experiencing little or no pain.

“I’ve spoken to many women who feel something is wrong, and don’t present the way men do,” she said. “It’s difficult to explain to medical personnel that nothing really hurts, but your body is telling you there is real trouble – somewhere.”

According to the British Heart Foundation, heart attack symptoms in women can develop suddenly or progress gradually. Vadali advised that any noticeable decline in physical ability, even over a short period, should prompt medical evaluation.

She cited the example of a young patient who unexpectedly became unable to climb a single flight of stairs after previously managing two without difficulty. The woman was later found to require urgent cardiac treatment.

Experts also warn that women often attribute warning signs to stress, anxiety or poor fitness, delaying medical assessment.

“There’s an under-appreciation of cardiovascular risks in women,” said Dr Americo Simonini, a cardiovascular specialist at Cedars-Sinai Medical Center in Los Angeles.

Beyond routine screening for blood sugar, cholesterol and blood pressure, Simonini said additional tests can provide a more comprehensive assessment of cardiovascular risk.

One important marker is high-sensitivity C-reactive protein (hs-CRP), which measures inflammation in the body. Elevated levels may indicate inflammation within blood vessels and an increased likelihood of cardiovascular disease.

Testing for lipoprotein(a), or Lp(a), can identify inherited forms of elevated LDL, commonly known as “bad” cholesterol. High levels are associated with greater plaque buildup inside arteries and a higher risk of heart attack.

Doctors may also measure apolipoprotein B (ApoB), a protein carried by cholesterol-containing particles that contribute to plaque formation within blood vessels. Increased ApoB levels are considered another indicator of cardiovascular risk.

Another diagnostic tool is the coronary artery calcium (CAC) score, obtained through specialised imaging. A high CAC score suggests significant calcium deposits within the coronary arteries, indicating a greater burden of plaque and an increased risk of future heart attack.
Simonini also challenged the belief that women remain protected from heart disease until menopause.
“There is a misconception that women are protected until menopause. That’s simply not true,” he said.

Although the risk of coronary artery disease generally increases after menopause as oestrogen levels decline, specialists emphasise that women can develop cardiovascular disease at any age. Early recognition of symptoms, combined with appropriate risk assessment and diagnostic testing, remains critical to improving outcomes.